Ebola epidemic in West Africa could rise to rival HIV in scope

As the number of Ebola patients continues to climb in West Africa, concern is growing among medical and development experts that the scourge could become as serious as the one posed by HIV a decade ago – and could be far more difficult to control.

The prospect engenders fears not only that what had been an occasional and easily controlled disease that in the previous 40 years had struck only 1,600 people will become a constant presence in the region, but that it also will sap what little economic energy exists in the poor nations where it is currently felt most seriously, Liberia, Sierra Leone and Guinea.

Experts note that the HIV/AIDS epidemic that swept southern Africa in the early 2000s required billions in international aid to bring under control and remains a major health concern throughout the continent.

“HIV is hard to get relative to Ebola,” said David Evans, a World Bank senior economist and the author of a recent World Bank study on Ebola’s likely impact. “I actually expect if we don’t get this under control quite quickly, we could see something even worse than what we saw with HIV in the early part of the century.”

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“Almost anywhere it spreads things are going to be much worse,” he said.

When the HIV/AIDS epidemic was at its peak and devastating poor African nations, the administration of President George W. Bush, with strong bipartisan support from Congress, initially committed $15 billion over five years to what was known as the President’s Emergency Plan for AIDS Relief. The administration of President Barack Obama added to the program, bringing to $52 billion total U.S. spending to date on programs to fight HIV/AIDS, tuberculosis and malaria in Africa.

In contrast, the United States’ current commitment to fight the Ebola epidemic is $1 billion, and international contributions to fight Ebola total just $257 million, with another $162 million pledged, according to the World Health Organization.

Meanwhile, Evans said, it’s impossible to know just how serious the epidemic will become. The World Bank, whose head, Jim Kim, is an epidemiologist and former WHO official, has projected that 100,000 will die from the disease and that the epidemic will be extinguished by the end of 2015. But the U.S. Centers for Disease Control and Prevention has suggested the death toll could reach 700,000.

“All these epidemiological projections show, frankly, we don’t really know how many cases there’re going to be,” Evans said. “There are huge variations across these projections.”

What is clear is that for now, there is little good news from West Africa about the epidemic. The most recent WHO update, released Wednesday, said transmission of Ebola has now been detected in seven countries, including the United States and Spain, and that the number of people infected with the virus has climbed to 8,997, the vast majority of those in Guinea, Liberia and Sierra Leone. Of those, 4,493 have died.The WHO said 427 health care workers had been infected through Sunday, a number that does not include a new case in Dallas reported Wednesday. Of those, 236 have died.

The World Health Organization’s official in charge of the Ebola response, Bruce Aylward, a Canadian, said that the WHO now anticipates that in the first week of December “the number of cases occurring per week is going to be somewhere between 5,000 to 10,000 a week. It could be higher, could be lower, but it’s going to be somewhere in that ballpark.”

That represents a sharp increase from the current number of new cases now being recorded, about 1,000 a week, but is consistent with a study published in September in the New England Journal of Medicine, which concluded that based on the first nine months of the outbreak Liberia, Sierra Leone and Guinea “would be reporting thousands of cases and deaths each week.”

“For the medium term, at least, we must face the possibility that (Ebola) will become endemic among the human population of West Africa, a prospect that has never previously been contemplated,” said the article, whose authors included Christopher Dye, the WHO’s director of strategy.

The economic costs of the epidemic are likely to be huge. A World Bank working paper on the Ebola outbreak estimated economic losses for West Africa, in the best-case scenario, would be $2.2 billion this year and $1.6 billion in 2015. But if the Ebola outbreak spreads to neighboring countries, those figures would zoom to $7.4 billion this year and $25.2 billion next year.

Based on other recent infectious disease outbreaks, such as the SARS epidemic of 2002-2004 and the H1N1 flu epidemic of 2009, most of that economic cost will come because people are too fearful to go to work or otherwise engage in activities that would put them potentially at risk.

That view was also reflected in a new study by Deutsche Bank, which said the Ebola epidemic is having an impact beyond the zones where the disease is prevalent. “Fear of contagion is altering people’s behavior, sometimes with significant economic consequences,” the bank said.

For example, the study noted, in nearby Nigeria “initial shock and fear” have led to a 20 percent to 40 percent drop in shopping mall purchases in Lagos, the capital. Tourism is another victim. “Westerners are canceling trips to various parts of Africa, including destinations far from West Africa,” the study said.

Michel Sidibe, the executive director of UNAIDS, the world agency that coordinates the international campaign against HIV, told a U.N. conference on trade and development in Geneva on Tuesday that the countries most affected by Ebola already had fragile health care systems. He noted that in Sierra Leone and Liberia, medical services were in short supply before the epidemic, with just one doctor available for every 100,000 inhabitants.

Fixing the medical system has to be a priority. “Unless we redress this imbalance first, of the issue of infrastructure, we can’t deal with emerging epidemics,” he said.

But WHO chief Chan said that’s an unrealistic expectation now. “You cannot build these systems up during a crisis. Instead, they collapse. A dysfunctional health system means zero population resilience to the range of shocks that our world is delivering with ever greater frequency and force.”

Sidibe, who comes from the West African nation of Mali, noted that the African continent “has 25 percent of the world’s disease burden but consumes less than 1 percent of the global health expenditure. We need to change this paradigm.”